“God forbid”, “No be my portion”, “Holy Ghost…fire!!!”
The above are typical statements many Nigerians, and by logical extension, hundreds of millions of people across Africa and the developing world would say in their various languages to supposedly ward off disastrous outcomes such as medical negligence. Unfortunately, like an apprentice sorcerer who cast a spell on himself instead of evaporating an opposing force, there is no substitute for diligence.
So, what characterises medical negligence? Firstly, there must be a duty of care, such as you have in a doctor-patient relationship. Secondly, it has to be established that the duty of care was breached. Also, it has to be clearly shown that the breach (assuming there was one) directly caused the injury or fatality. The fourth factor is damages – the fact that injury or fatality did occur. The damages could also be emotional or financial.
A couple of recent cases of alleged medical negligence in Nigeria come to mind. The death of Nkanu Nnamdi, the 21-month-old son of globally celebrated Nigerian author, Chimamanda Adichie and her husband, Dr Ivara Esege, is one. Nkanu, a twin, suffered a seizure and cardiac arrest at a private hospital in Lagos and sadly passed away in January 2026. The family alleges medical negligence, which the hospital, Euracare Multi-Specialist Hospital, denies. Lagos State Government has ordered an investigation, and rightly so. Equally heart-wrenching is the case of the mother of five, Aishatu Umar. A pair of surgical scissors was allegedly forgotten in her abdomen in September 2025 when she had an operation in Kano. For about four months, opportunities were missed to correct the alleged medical error. Sadly, Aishatu passed away in January 2026 during the operation to remove the scissors at another health facility in Kano, a few days after an X-ray was said to have revealed the object in her belly. Deepest condolences to both families.
Two defining moments in legal history deserve a mention. Bolam v Friern Hospital Management Committee [1957]. This case, commonly referred to as the Bolam Test, highlights the responsible body and reasonableness. In summary, the judgement which was in favour of the clinician was based on the principle that if a body of experts, even a minority opinion, holds the professional view that the action of the clinician was reasonable, that could tilt the judgement in favour of the clinician. Forty years later, this principle was reviewed and updated in Bolitho v City and Hackney Health Authority [1998]. While the Bolam Test still applies, the Bolitho case adds a proviso that the expert opinion must have a logical basis.
What other factors can either deter or provide an enabling environment for medical negligence to occur? A major one is us – we, the people. For patients, their carers, and the public, the biggest shift has to be our mindset. If you see something, say something. If fantastic, give a compliment. If detrimental, make a complaint. Know your rights, the duties and limitations of staff. The mindset of ‘God must have permitted it, so should not complain’ must no longer hold sway. Let us remember, our voice is our health!
Refresher courses, new development briefings, and regular training in various clinical and non-clinical aspects of health care delivery and management are crucially important. Employers in the public and private sectors must encourage their staff to engage in continuous learning and self-development.
It is commendable that, effective October 1, 2025, the Nigerian Association of Resident Doctors, with the support of the Federal Ministry of Health and Social Welfare, has mandated that resident doctors should not work for more than a 24-hour call, which must be followed by a call-free period. Astonishingly, some resident doctors were working up to 72-hour calls before this new directive, with all the attendant risks.
The culture of a healthcare facility is another vital factor. Championing a reporting system that promotes non-punitive, shared learning measures will yield better results than a policy rooted in punishment. The latter will foster a culture of fear and self-preservation, leading to errors being covered up. This brings to mind the Francis Inquiry in the UK, set to address the health scandal that erupted at the Mid Staffordshire NHS Foundation Trust, which caused preventable deaths of many patients between 2005 and 2009. One of the key recommendations by Robert Francis QC is the “Duty of Candour”, making it mandatory for care providers to be transparent in their communication with patients, their families, as well as regulators when things go wrong.
In the West, the concept of whistleblowing, staff who confidentially report their colleagues whose work may put patients at risk, is being increasingly embraced to improve the quality of care. In the UK, for example, most of the criminal and unprofessional practices in care settings were brought to light either by an independent public inquiry or by the hidden cameras of Panorama – a BBC investigative documentary series. Some argue that facilities that shy away from using whistleblowers may end up with a Panorama exposé.
The role of government cannot be overemphasised. Our laws must demonstrate currency, fit for purpose in today’s AI and robotics age. The establishment of the National Task Force on Clinical Governance and Patient Safety, announced on January 15, 2026, deserves our commendation.
The setting of standards, regulating training, and accrediting training institutions in medicine and dentistry falls within the remit of the Medical and Dental Council of Nigeria. The MDCN also maintains professional registers, responsible for codes of conduct as well as deciding disciplinary measures to be taken against erring practitioners. These are vital and wide-ranging remits, hence the need for adequate resources.
Having a system that monitors stock levels of drugs and essential materials is fundamental, just as having a central alert system when equipment/machines are malfunctioning and need to be repaired or replaced. Considering the epileptic supply of power in the country, how terrible would it be to have a sudden power cut when doing your own cutting in the theatre?!
So, let us embrace an organismic approach, appreciating that the whole is greater than the sum of its parts. No wand-wielding sorcerer or the chanting of ‘Holy Ghost …fire!!!’ can keep medical negligence at bay. People, systems, machines/materials/technology and their interconnections must be our focus.
Thomas is the CEO of Patient Academy International
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